|本期目录/Table of Contents|

[1]盛正成,沈天一,周昱霖,等.机器人辅助腹腔镜肾盂成型术联合加速康复治疗肾盂输尿管连接部梗阻[J].医学研究与战创伤救治(原医学研究生学报),2020,22(5):497-500.[doi:10.3969/j.issn.1672-271X.2020.05.010]
　SHENG Zheng-cheng,SHEN Tian-yi,ZHOU Yu-lin,et al.Robot-assisted laparoscopic pyeloplasty combined with enhanced recovery after surgery in the treatment of ureteropelvic junction obstruction[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2020,22(5):497-500.[doi:10.3969/j.issn.1672-271X.2020.05.010]
点击复制

机器人辅助腹腔镜肾盂成型术联合加速康复治疗肾盂输尿管连接部梗阻()
分享到62.8K

《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第22卷
期数:
2020年5期
页码:
497-500
栏目:
临床研究
出版日期:
2020-09-09

文章信息/Info

Title:
Robot-assisted laparoscopic pyeloplasty combined with enhanced recovery after surgery in the treatment of ureteropelvic junction obstruction
作者:
盛正成; 沈天一; 周昱霖; 张征宇; 葛京平; 周文泉
作者单位：210002南京，南京医科大学金陵临床医学院（东部战区总医院）泌尿外科（盛正成、沈天一、周昱霖、张征宇、葛京平、周文泉）
Author(s):
SHENG Zheng-cheng;  SHEN Tian-yi;  ZHOU Yu-lin;  ZHANG Zheng-yu;  GE Jing-ping;  ZHOU Wen-quan
(Department of Urology, Jinling Clinical Medical College Affiliated to Nanjing Medical University/General Hospital of Eastern Theater Command, PLA, Nanjing 210002, Jiangsu, China)
关键词:
加速康复外科; 肾盂输尿管连接部梗阻; 机器人辅助腹腔镜肾盂成型术; 微创手术
Keywords:
enhanced recovery after surgery;  ureteropelvic junction obstruction;  robot-assisted laparoscopic pyeloplasty;  minimally invasive surgery
分类号:
R619
DOI:
10.3969/j.issn.1672-271X.2020.05.010
文献标志码:
A
摘要:
目的探讨机器人辅助腹腔镜肾盂成型术联合加速康复治疗肾盂输尿管连接部梗阻的可行性和有效性，观察临床疗效。方法回顾性分析2014年11月至2019年12月东部战区总医院泌尿外科收治的的肾盂输尿管连接部梗阻48例患者的临床资料，所有患者均接受机器人辅助腹腔镜肾盂成型术。2017年11月前的26例患者围术期按传统方法治疗（传统组，n=26)。2017年12月及以后的患者围术期采用加速康复外科(ERAS)策略（ERAS组n=22）。对比分析2组患者临床资料、围术期指标、术后随访结果。结果ERAS组和传统组患者手术时间[(100.23±21.18）min vs (109.39±22.97）min]、术中失血量[(21.13±8.29)mL vs (20.09±7.40)mL]、入院C反应蛋白[(0.91±1.59）mg/L vs (0.59±0.23）mg/L]、血白细胞计数[（5.66±0.91)×109/L vs (6.16±1.22)×109/L]、术后24 h疼痛评分（0.79±0.22 vs 0.84±0.22）、术后复查肾盂分离程度比较差异无统计学意义（P>0.05）。术后48 h疼痛评分（0.80±0.26 vs 1.42±0.20）、术后72 h疼痛评分（0.84±0.24 vs 1.81±0.37）、术后C反应蛋白[（22.72±7.05）mg/L vs (40.24±13.91）mg/L]、术后血白细胞[（8.45±1.06)×109/L vs (11.14±1.34)×109/L]、肠道功能恢复时间[（46.31±8.59)h vs (59.47±16.20)h]、术后住院时间[（4.86±1.69)d vs (6.79±2.37)d]、腹腔引流管移除时间[（2.18±1.09)d vs (8.04±1.34)d]、双J管移除时间[（20.77±4.74)d vs (75.28±15.55)d）]、围术期并发症发生率（4.5% vs 15.3%）、双J管相关并发症发生率（18.0% vs 34.6%）差异有统计学意义(P<0.05)。结论优化的ERAS策略结合达芬奇手术机器人治疗肾盂输尿管连接部梗阻是安全有效的围术期处理策略，值得在临床推广。
Abstract:
ObjectiveTo observe the feasibility and effectiveness of robot-assisted laparoscopic pyeloplasty combined with accelerated rehabilitation in the treatment of ureteropelvic junction obstruction.MethodsForty-eight patients with ureteropelvic junction obstruction admitted to the Department of Urology of the Eastern Theater General Hospital of the Chinese people’s Liberation Army from November 2014 to December 2019 were retrospectively analyzed. All patients received robot-assisted laparoscopic pyeloplasty. The patients before November 2017 were treated according to the traditional method during the perioperative period, which was the traditional group (n=26). Patients in December 2017 and beyond were divided into accelerated rehabilitation (enhanced recovery after surgery, ERAS) group (n=22) and ERAS strategy was used in perioperative period. The clinical data, perioperative parameters andpostoperative follow-up results of two groups were compared and analyzed.ResultsIn ERAS group and traditional group, the operation time, intraoperative blood loss, admission C-reactive protein, white blood cell count, postoperative pain score and postoperative pain score were (100.23±21.18）min vs (109.39±22.97）min, (21.13±8.29)mL vs (20.09±7.40)mL, (0.91±1.59）mg/L vs (0.59±0.23）mg/L, （5.66±0.91)×109/L vs (6.16±1.22)×109/L, 0.79±0.22 vs 0.84±0.22, respectively. There was no significant difference in the degree of renal pelvis separation after operation (P>0.05). Postoperative 48 h pain score （0.80±0.26 vs 1.42±0.20）, 72 h pain score （0.84±0.24 vs 1.81±0.37）, postoperative C-reactive protein [（22.72±7.05）mg/L vs (40.24±13.91）mg/L], postoperative WBC [（8.45±1.06)×109/L vs (11.14±1.34)×109/L], intestinal function recovery time [（46.31±8.59)h vs (59.47±16.20)h], postoperative hospital stay [（4.86±1.69)d vs (6.79±2.37)d]. There were significant differences in removal time of abdominal drainage tube [（2.18±1.09)d vs (8.04±1.34)d], removal time of double J tube [（20.77±4.74)d vs (75.28±15.55)d）], incidence of perioperative complications (4.5% vs 15.3%) and incidence of complications related to double J tube (18.0% vs 34.6%).ConclusionThe optimized ERAS strategy combined with Leonardo da Vinci surgical robot in the treatment of ureteropelvic junction obstruction is a safe and effective perioperative management strategy, which is worth popularizing in clinic.

参考文献/References:

[1]Mufarrij PW, Woods M, Shah OD, et al. Robotic dismembered pyeloplasty: a 6-year, multi-institutional experience[J]. J Urol, 2008,180(4):1391-1396.
[2]Casale P. Robotic pyeloplasty in the pediatric population[J]. Curr Opin Urol, 2009,19(1):97-101.
[3]Autorino R, Eden C, El-Ghoneimi A, et al. Robot-assisted and laparoscopic repair of ureteropelvic junction obstruction: a systematic review and meta-analysis[J]. Eur Urol, 2014,65(2):430-452.
[4]葛京平, 汤昊, 魏武, 等. 机器人辅助经腹腹腔镜与后腹腔镜离断式肾盂成形术的比较研究[J]. 医学研究生学报, 2013,26(12):1272-1274.
[5]Kehlet H. Fast-track colorectal surgery[J]. Lancet, 2008,371(9615):791-793.
[6]时昌杰, 盛正成, 张莹, 等. 加速康复外科技术在腹腔镜前列腺癌根治术患者围术期的应用[J]. 东南国防医药, 2019,21(4):360-364.
[7]李明辉, 赵晓智, 郭宏骞. 加速康复外科在后腹腔镜肾癌根治术中的应用[J]. 医学研究生学报, 2012,25(9):930-932.
[8]唐朝朋, 徐振宇, 高建平, 等. 加速康复外科在腹腔镜肾癌根治术中应用的安全性及有效性研究[J]. 腹腔镜外科杂志, 2012,17(12):935-939.
[9]Miyaoka R, Monga M. Ureteral stent discomfort: Etiology and management[J]. Indian J Urol, 2009,25(4):455-460.
[10]李杰, 苟欣, 邓远忠, 等. 输尿管镜钬激光碎石后双J管留置时间与并发症研究[J]. 重庆医科大学学报, 2010,35(6):935-937.
[11]Komeya M, Usui K, Asai T, et al. Outcome of flexible ureteroscopy for renal stone with overnight ureteral catheterization: a propensity score-matching analysis[J]. World J Urol, 2018,36(11):1871-1876.
[12]平秦榕, 李健, 张宏景, 等. 输尿管软镜治疗中上盏肾结石术后无管化的临床研究[J]. 中华泌尿外科杂志, 2019,40(2):100-104.
[13]Nasser FM, Shouman AM, ElSheemy MS, et al. Dismembered Pyeloplasty in Infants 6 Months Old or Younger With and Without External Trans-anastomotic Nephrostent: A Prospective Randomized Study[J]. Urology, 2017,101:38-44.
[14]Khoder WY, Waidelich R, Ghamdi AMA, et al. A prospective randomised comparison between the transperitoneal and retroperitoneoscopic approaches for robotic-assisted pyeloplasty in a single surgeon, single centre study[J]. J Robot Surg, 2018,12(1):131-137.
[15]Traumann M, Kluth LA, Schmid M, et al. Robot-assisted laparoscopic pyeloplasty in adults: Excellent long-term results of primary pyeloplasty[J]. Urologe A, 2015,54(5):703-708.
[16]Sforza S, Di Maida F, Mari A, et al. Is a Drainage Placement Still Necessary After Robotic Reconstruction of the Upper Urinary Tract in Children? Experience from a Tertiary Referral Center[J]. J Laparoendosc Adv Surg Tech A, 2019,29(9):1180-1184.

相似文献/References:

[1]刘兴东综述,嵇 武,李 宁审校.外科新理念在肠道损伤救治中的应用进展[摘要][J].医学研究与战创伤救治(原医学研究生学报),2011,13(01):59.
[2]杨仁荣,曹金林,刘文滨,等.损伤控制与加速康复外科理念在心脏刀刺伤急救中应用[J].医学研究与战创伤救治(原医学研究生学报),2011,13(06):488.
　YANG Ren-rong,CAO Jin-lin,LIU Wen-bin,et al.Clinical application of damage control and fast track surgery in the first aid of cardiac stabbed[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2011,13(5):488.
[3]马宏青,程 文,高建平,等.后腹腔镜肾盂成形术(附52例报告)[J].医学研究与战创伤救治(原医学研究生学报),2010,12(04):296.
　MA Hong-qing,CHENG Wen,GAO Jian-ping,et al.Retroperitoneal laparoscopic pyeloplasty (52 cases)[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2010,12(5):296.
[4]邓 欢,赵丽君,吴金玲,等.加速康复外科护理在腹腔镜胃癌根治术患者中的应用[J].医学研究与战创伤救治(原医学研究生学报),2014,16(02):199.[doi:10.3969/j.issn.1672-271X.2014.02.029]
[5]李坤,赵丽君,韩晓鹏,等.损伤控制外科及加速康复外科理念在腹腔镜胃癌根治术中的应用[J].医学研究与战创伤救治(原医学研究生学报),2014,16(05):460.[doi:10.3969/j.issn.1672-271X.2014.05.004]
　LI Kun,ZHAO Li-jun,HAN Xiao-peng,et al.Application of damage control surgery and fast tract surgery in patients underwent laparoscopic radical gastrectomy[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2014,16(5):460.[doi:10.3969/j.issn.1672-271X.2014.05.004]
[6]曹媛媛,杨 洋,刘伟娇,等.加速康复外科护理对胃癌术后早期离床活动的影响[J].医学研究与战创伤救治(原医学研究生学报),2015,17(04):432.[doi:10.3969/j.issn.1672-271X.2015.04.031]
[7]徐杨,丛壮壮,冀赛光,等.C-反应蛋白与清蛋白比值对微创食管癌术后并发症的早期预测价值[J].医学研究与战创伤救治(原医学研究生学报),2018,20(04):371.[doi:10.3969/j.issn.1672-271X.2018.04.010]
　XU Yang,CONG Zhuang-zhuang,JI Sai-guang,et al.Predictive value of the postoperative ratio of C-reactive protein to albumin for complications afterminimally invasive esophageal surgery[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2018,20(5):371.[doi:10.3969/j.issn.1672-271X.2018.04.010]
[8]时昌杰,盛正成,张莹,等.加速康复外科技术在腹腔镜前列腺癌根治术患者围术期的应用[J].医学研究与战创伤救治(原医学研究生学报),2019,21(4):360.[doi:10.3969/j.issn.1672-271X.2019.04.006]
　SHI Chang-jie,SHENG Zheng-cheng,ZHANG Ying,et al.Application of fast track surgery in the perioperative period of laparoscopic radical prostatectomy[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2019,21(5):360.[doi:10.3969/j.issn.1672-271X.2019.04.006]
[9]田淑娜,陈琪珍,马丽,等.加速康复外科理念在单孔腹腔镜下子宫肌瘤剔除术中的应用[J].医学研究与战创伤救治(原医学研究生学报),2019,21(6):608.[doi:10.3969/j.issn.1672-271X.2019.06.012]
　TIAN Shu-na,CHEN Qi-zhen,MA Li,et al.Application of enhanced recovery after surgery concept in patients undergoing single hole laparoscopic myomectomy[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2019,21(5):608.[doi:10.3969/j.issn.1672-271X.2019.06.012]
[10]郭嵩,王刚,高国宇,等.加速康复外科在甲状腺乳头状癌手术中的应用[J].医学研究与战创伤救治(原医学研究生学报),2021,23(01):69.[doi:10.3969/j.issn.1672-271X.2021.01.001]

备注/Memo

备注/Memo:
-
更新日期/Last Update: 2020-09-09